Maternal life history- versus gestation-focused assessment of prenatal exposure to substances of abuse

Purpose: Substance use by pregnant women is socially stigmatized and may be legally punishable. This societal condemnation raises concerns about under ascertainment of prenatal substance exposure of offspring if mothers are as ked specifically about their behavior during gestation, versus their life h istories without reference to gestational dates. This study assessed agreem ent between life history focused and pregnancy-focused assessments of prena tal exposure, and percentages of offspring classified as exposed to a range of substances by each measure, in a sample of school-aged children of meth adone-maintained, opioid-dependent parents. Methods: Prenatal exposure was assessed in 172 offspring of 109 mothers by: (a) questionnaires administere d to mothers about substance use during pregnancy; and (b) best-estimate (B E) diagnoses of substance use disorders in mothers overlapping with pregnan cy dates. BE diagnoses were based on interviews with the Schedule for Affec tive Disorders and Schizophrenia-Lifetime Version, conducted by trained men tal health professionals with mothers about their life histories of psychia tric and substance use disorders, as,cell as mothers' medical records. Chan ce-corrected agreement between the measures was examined using kappa statis tics. Percentages of offspring classified as exposed by each method,cere co mpared using McNemar chi (2) tests. Results: Except for cigarettes, agreeme nt between the measures was poor Except for alcohol, diagnosed episodes of substance use disorders irt mothers with dates overlapping pregnancy classi fied more offspring as exposed than mothers' responses to the questionnaire focusing an behavior while pregnant, though the differences in proportions identified as exposed were not always large or statistically significant. implications: When retrospective ascertainment of prenatal exposure is nece ssary asking mothers for their own life histories, without reference to pre gnancy dates, may, be the preferred approach.